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From the 7/23/2021 release of VAERS data:

This is VAERS ID 992082



Case Details

VAERS ID: 992082 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-01-24
Onset:2021-01-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EI3249 / 2 AR / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Culture urine negative, Death, Full blood count normal, General physical health deterioration, Hemiparesis, Metabolic function test, Metabolic function test normal, Mobility decreased
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-28
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Rocephin, depakote sprinkles, metoprolol, trazodone, famotidine, certevite, mylanta, vit D, zocor, keppra, aspirin, tylenol, tricor.
Current Illness: None
Preexisting Conditions: Supraventricular Tachycardia, cerebral palsey, epilepsy,
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Resident was noted on 1/25 with an increased functional decline as she would not feed herself with utensils, but would eat finger foods if placed in her hand. She was started on Rocephin IM for possible infections. Labs had been obtained on 1/21/21, unremarkable for CBC and CMP. 75,000 colony count on urine. On 1/26/21 she was noted with right sided weakness and further decline. She was sent to Hospital for further evaluation. We were notified that she expired on 1/28/2021. Resident had been noted with a decline in function about 2 weeks earlier when she would not stand or transfer any longer. She was still responsive, taking meds, and feeding herself until 1/26/21. Further information on admitting diagnoses and progress notes from hospital have not been available to date.


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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=992082


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